经后路椎弓根侧方入路病灶清除联合椎间植骨内固定术治疗强直性脊柱炎合并胸腰段Andersson病损

Debridement and interbody fusion via posterior pedicle lateral approach for ankylosing spondylitis with thoracolumbar Andersson lesion

目的探讨经后路椎弓根侧方入路病灶清除联合椎间植骨内固定术治疗强直性脊柱炎合并胸腰段Andersson病损(Andersson lesion,AL)的安全性及疗效。方法 2011年10月-2017年1月,采用经后路椎弓根侧方入路病灶清除、椎间植骨内固定术治疗10例强直性脊柱炎合并胸腰段AL患者。其中男8例,女2例;年龄31~79岁,平均48.8岁。病程1.5~48.0个月,平均10.6个月。病变节段:T10、11 3例,T11、12 4例,T12、L1 3例。术前疼痛视觉模拟评分(VAS)为(8.0±0.8)分,Oswestry功能障碍指数(ODI)为68.8%±5.5%。局部后凸Cobb角为(26.3±7.1)°。神经功能根据美国脊髓损伤协会(ASIA)评分系统评估,C级1例、D级4例、E级5例。结果 10例患者均顺利完成手术,手术时间120~185 min,平均151.5 min;术中出血量300~750 mL,平均450.0 mL。1例术中发生硬膜囊撕裂,经修补后未发生脑脊液漏。术后患者均获随访,随访时间24~50个月,平均31.2个月。末次随访时VAS评分为(1.9±0.9)分,ODI为13.0%±3.0%,与术前比较差异均有统计学意义(t=17.530,P=0.000;t=31.890,P=0.000)。术后24个月神经功能ASIA分级均为E级。影像学复查显示,术后3 d和24个月局部后凸Cobb角分别为(12.6±4.6)°和(13.6±4.6)°,与术前比较差异有统计学意义(P<0.05);术后3 d与24个月间差异无统计学意义(P>0.05)。术后24个月AL节段植骨融合良好。随访期间无退钉、断钉、断棒等内固定失败发生。结论经后路椎弓根侧方入路病灶清除、椎间植骨内固定术治疗强直性脊柱炎合并胸腰段AL,患者临床症状改善满意,能获得良好骨性愈合及一定程度局部后凸畸形改善。

Objective To investigate the safety and effectiveness of debridement and interbody fusion via posterior pedicle lateral approach in treatment of ankylosing spondylitis with thoracolumbar Andersson lesion(AL).Methods Between October 2011 and January 2017, 10 patients of ankylosing spondylitis with thoracolumbar AL were treated with debridement via posterior pedicle lateral approach and interbody fusion with bone grafting. There were8 males and 2 females with an average age of 48.8 years(range, 31-79 years). The disease duration was 1.5-48.0 months(mean, 10.6 months). All patients were single-segment lesion, including 3 cases of T10, 11, 4 cases of T11, 12, and 3 cases of T12, L1.The preoperative visual analogue scale(VAS) score was 8.0±0.8, the Oswestry disability index(ODI) was 68.8%±5.5%, and the Cobb angle of local kyphosis was(26.3±7.1)°. According to American Spinal Injury Association(ASIA) scoring system,neurological impairment was assessed in 1 case of grade C, 4 cases of grade D, and 5 cases of grade E. Results All the operations of 10 patients completed successfully. The operation time was 120-185 minutes(mean, 151.5 minutes), and the intraoperative blood loss was 300-750 mL(mean, 450.0 mL). Dural sac tear occurred in 1 case during operation and was repaired, with no cerebrospinal fluid leakage after operation. All patients were followed up 24-50 months(mean, 31.2 months). At last follow-up, the VAS score was 1.9±0.9 and ODI was 13.0%±3.0%, showing significant differences when compared with preoperative ones(t=17.530, P=0.000;t=31.890, P=0.000). Neurological function was improved significantly at 24 months after operation, and rated as ASIA grade E. The Cobb angles were(12.6±4.6)° at 3 days and(13.6±4.6)° at 24 months after operation, which were significantly different from those before operation(P<0.05);there was no significant difference between 3 days and 24 months after operation(P>0.05). At 24 months after operation, the grafted bone obtained good fusion at AL segment. During the follow-up, there was no failure of internal fixation such as nail withdrawal, broken nail, and broken rod. Conclusion Debridement and interbody fusion via posterior pedicle lateral approach for the ankylosing spondylitis with thoracolumbar AL can achieve satisfactory effectiveness, good fusion,and a certain correction of local kyphosis.